hushpiper

Antidepressants are wonderful, life-saving medications. There’s a large range of them available to suit different specific brain chemistries. They can have un-fun but generally non-dangerous side effects, but if they are the thing you need then they can change your life. However, they have one really big downside: the condition they treat (unipolar depression) is difficult or sometimes impossible to distinguish from a condition that they can greatly exacerbate or outright trigger (bipolar depression), at serious and long-lasting cost to the patient.

Meanwhile lamotrigine is a cheap, safe mood stabilizer with one (1) major side effect (the possibility of a bad rash when beginning or raising the dose), which is very rare and goes away quickly if you stop or lower the dose.¹ It works really well for bipolar depression, fairly well for bipolar mania, and even works for some unipolar depression, BPD and PTSD. Its only downside is that it might not work for you.

For some godforsaken reason, despite all this, lamotrigine is not first-line treatment for depression. I find this scandalous and infuriating, especially given how awful mental health professionals generally are at recognizing bipolar disorder. So for you, dear reader at whom I have probably flung this article while screaming into a pillow, I provide a list of good times for a person with depression to consider bipolar meds and/or a bipolar spectrum diagnosis:

• When going to the doctor for depression for the first time;


• When going to the doctor for depression for the second time;


• When considering taking an antidepressant;


• When you haven’t tried lamotrigine yet;


• When 3+ antidepressants have failed to fully address your depression;


• When one or more antidepressants made your depression worse, or made you feel very anxious or agitated, or gave you insomnia;


• When one more or antidepressants have worked well for your depression but then suddenly and mysteriously stopped working;


• When your depression includes the type of anxiety characterized by general sense of itchy/skin-crawly bad vibrating energy, inability to sit still or pay attention, racing or circling negative thoughts, or irritable outbursts (this does not need to fit criteria for hypomania);


• When your depression comes with intense insomnia or sleep schedule fuckery;


• When your depression comes with very low energy, excessive sleep, and your mood responds to your environment (happy or exciting things make you temporarily happy or excited but the depression does not lift);


• When your first depressive episode came early in your life (earlier than twenty-five, moreso if it was late teens or even younger);


• When you find that when not depressed, you are somewhat more creative, sociable, or energetic than most people;


• When you have had psychosis during depression, or post-partum depression;


• When you HAVE RELATIVES WITH BIPOLAR LSKHDFSD

Signed,

Someone who is so, so fucking tired of constantly spotting bipolar spectrum disorders in people that their doctors have fucking missed.
 

---

¹It can also make your mood shoot up if you’re bipolar and currently cycling. (Though it could also just stop your cycling out the gate–that is more common, from what I know.) Once you’re up to the target dose (100-200mg) that goes away. If you’re bouncing off the walls in the meantime you can temporarily take some lithium to control it. On 25mg I went through about a week of intense hypomania that dropped like a stone the moment I bumped up to 50mg. Talk to your doc, but I recommend you bear through it.

²For more information on all of this, including copious links to studies and discussion from an experienced medical doctor, check out psycheducation.org.